Varicose veins often begin in adolescence, although they may occur later in adulthood. Major predisposing factors include heredity, pregnancy and hormonal factors. Other contributing factors can include a sedentary life style, prolonged standing, obesity, leg injury, hot weather, and intensive high impact sports. Sometimes varicose veins can lead to significant medical problems that may include pain, swelling, phlebitis, discoloration of the skin in the lower leg and ulceration. Varicose veins are typically chronic and often progressive.
LEG VEIN BASICS
The leg veins are divided into superficial veins (near the skin) and deep veins (which lie deep to the muscles in the leg). The major connections between the deep and superficial systems are in the groin region and the area behind the knee. There are also connecting veins known as perforating veins since they perforate the capsule around muscles in order to connect the superficial veins with the deep veins. The perforating veins are scattered throughout the leg.
These two systems work together to get de-oxygenated blood back to the heart so it can be re-circulated through the lungs to pick up more oxygen. The superficial system primarily acts as a collecting system. It collects blood from the muscles and other structures after the oxygen has been removed from the blood. The deep system actively transports the blood up to the heart. These systems must work in concert, with the deep system moving some blood up and then, filling again with blood from the superficial veins. The pump or force that allows this to happen is contraction of the calf muscles.
In other words, when you take a step the contraction of the calf muscles squeezes the blood up in the deep veins. As the muscle relaxes the deep system can fill back up with blood from the superficial veins and then with the next contraction (or step) more blood is squeezed up again. What keeps the blood from just running back down again the wrong direction? Most veins in the legs have tiny one way valves that only allow blood to flow in one direction thus preventing the blood from flowing backwards.
WHAT IS A VARICOSE VEIN?
A varicose vein is a dilated superficial vein that has enlarged due to increase pressure in the vein. The increased pressure is largely due to leaky valves and a back-up of blood in the vein with the leaky valve or a nearby vein. The source of the leak can be at one of the major connection sites between the two systems, in a perforating vein, or isolated to a superficial vein.
What size of vein do we call varicose? By definition any vein that is enlarged can be called varicose. The underlying problem when dealing with a spider vein or a large rope-like vein is the same; increased pressure in the vein resulting from leaky valves and thus disruption of normal blood flow.
EVALUATION OF LEG VEINS
The most important part of the evaluation is a good history and physical exam. The history focuses on risk factors for developing veins or complication of varicose veins. By identifying these factors you can modify your lifestyle which can make positive changes regarding varicose veins. The physical exam is very important to identify the exact area of problems.
For example, you may just have a few spider veins present on inspection but actually have a problem with the deeper system or at a site where the superficial system connects to the deep system. The spider veins are pressure offshoots in the skin for the deeper problem. This evaluation is important to determine the best treatment plan.
Using the same example, if just the superficial spider veins are treated without addressing the deeper source of the increased pressure, treatment is more difficult and you will likely just develop new spider veins in the same area. You should always have a careful evaluation of your leg veins before any treatment is undertaken including laser for spider veins.